| NPI | 1912393703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: WI 68070) |
| Additional Taxonomies | 207UN0902X Nuclear Medicine, Nuclear Imaging & Therapy (Licence: WI 68070) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 5848) | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2021-06-23 |